"Even with all those advancements we still have to wonder why patients need to wait at all," he said.

Meanwhile, Ruis said another reason for delays is simply the high demand for the cards. The volume slows down the system.

"I would be happy with a three- to five-day turnaround time just given some of the challenges we've had with staffing, with filling positions," she said.

State Sen. Will Espero, vice chair of the Senate Public Safety, Intergovernmental and Military Affairs Committee, said it will only get more challenging for the state when Hawaii's dispensaries open.

"We are expecting that there's a strong possibility that you're going to see an upsurge in medical marijuana patients and applications," he said.

Carl Bergquist, executive director of the Drug Policy Forum of Hawaii, said a patient in pain or dealing with nausea "and who chooses medical cannabis, deserves relief as quickly as as those who resort to medications like opiods that often are dangerous and addictive."

For her part, Ruis said she and her staff are working as quickly as they can.

"We care about the patients and we care about public safety. I do believe we will be able to make it even better," she said.